Coping with short-term memory problems: Part 3
By Dr Sue Jackson & Dr Anna Crown
This is the final article is the series focussed on short term memory problems; why we experience them and what we can do to cope. In previous articles we have considered the three key components that comprise short term memory, and then detailed the common problems for each which leads to the experiences that we describe as short term memory problems. We have also considered the three most common causes of short term memory loss listed on the NHS Choices website: anxiety, stress & depression.
Everything we’ve covered so far is summarised in Table 1.
Table 1: The key components of short term memory (STM) and their associated common problems
STM memory components
Ideas for coping
Or how interesting something is to you
Lack of interest, or relevance, to you
Other competing priorities
Mood state (anxious, depressed, frustrated, excited)
Try to do things one at a time
Try to find a mutually convenient time to talk to others (or use written notes)
Learn to recognise your mood & emotion states
As above, plus:
Short concentration span
Health status (e.g. having a cold)
Pressing bodily needs (e.g. thirst)
Poor diet or nutritional status
Poor sleep and/or high levels of fatigue
As above, plus:
Try to practice good self-care
Make sure you get enough rest
Try to take enough physical exercise
Talk to yourself nicely
Use your senses to enjoy the world
Work on using your body to tell your mind that everything is OK (e.g. holding your hands open, relaxing your arms and holding your posture open)
Your ability to remember later on
As both of the above, plus:
Trying to use your memory for too many things
Too many items on your list of things to do
A random and/or confused list of things to do
Lack of appropriate social cues
As both of the above, plus:
Use short, sensibly ordered lists
Ask yourself: what do I need to do? When do I need to do it? What to do I need to remind me?
While we’ve covered a lot of ground in relation to short term memory, we’ve yet to address the particular issues faced by pituitary patients, so that’s the focus for this article.
Many studies have shown that patients with pituitary problems are more likely to have problems with memory, concentration and attention than patients with other medical conditions. The precise cause of any memory problems is hard to pin down: it may be related to the pituitary problem itself, treatment with surgery or radiotherapy, hormone excess or hormone deficiencies. Effects are also influenced by age at diagnosis and treatment (whether in childhood, young adulthood, middle or old age).
Some pituitary conditions have been studied more than others in relation to memory. Cushing’s syndrome (excess cortisol production) is associated with specific memory problems. Scientists have focussed on the hippocampus, a small area of the brain shaped like a sea-horse, which is important for forming, placing and accessing memories in the cerebral cortex (the brain’s ‘hard drive’). MRI scans of patients with Cushing’s syndrome show that the hippocampus has shrunk compared to the rest of the brain, like a desiccated little sea-horse. In rat experiments, the shrinkage has been shown to be caused by shrivelling of the connections within the neural network.
The positive aspect of this research is that after normalisation of cortisol levels, the shrinkage of the hippocampus is reversed. However, most endocrinologists recognise that some patients treated for Cushing’s syndrome do not feel that their memory fully recovers, even after successful treatment. An eminent medical scientist, Robert Sapolsky, has written a very readable book about this and other health problems that may be related to stress hormones, called ‘Why zebras don’t get ulcers – an updated guide to stress, stress-related diseases and coping’.
Growth hormone also seems to have a role in memory. Both acromegaly (excess growth hormone production) and growth hormone deficiency may be associated with problems with memory and attention. Treatment of the acromegaly or the growth hormone deficiency may be helpful and improve memory problems, though once again, patients may not feel fully recovered.
Patients who have very low levels of thyroid hormone (hypothyroidism) may develop memory problems. If the hypothyroidism is very prolonged and severe before it is treated, patients’ mental functioning may become so slowed up that they appear to be developing dementia. This is unusual, particularly when the hypothyroidism is due to a pituitary problem. It is reversible with treatment, though there may be a ‘lag’ phase of several months before patients feel fully recovered. Over-treatment with thyroid hormone may cause problems with a reduced attention span affecting memory, but provided the thyroid blood tests are monitored and the dose of thyroid hormone is adjusted appropriately, this shouldn’t happen.
Patients with adrenal insufficiency (low cortisol levels) can get impaired memory, though lethargy, fatigue and weakness are more common. This is also reversible fairly promptly with hydrocortisone treatment. In general, as with most things in life, you need ‘just enough’ of each hormone: too little or too much can cause memory problems.
Some patients with craniopharyngiomas, which may extend beyond the pituitary to the hypothalamus and adjacent areas of the brain, may find that their memory is affected by the craniopharyngioma itself, or by its treatment. Surgery for craniopharyngiomas may be need to be more extensive than standard pituitary surgery, and may require the surgeon to disturb brain tissue during the operation. For each patient, the pituitary team, including the neurosurgeon, will discuss carefully the possible risks and likely benefits of any treatment they recommend.
Studies have tried to see whether pituitary radiotherapy itself might cause memory problems. No major influence has been shown, though there are so many differences between individual pituitary patients (for example, age, type of pituitary problem, duration of problem, types of treatment received, hormone status etc) that it is hard to pick out any effect that may be specifically related to radiotherapy treatment. It is also difficult to organise studies that are large enough and go on for long enough (many years) to detect what may potentially be a very small effect (if any).
Apart from the need to develop cognitively, generally speaking young children inhabit the world in a very different way than adults do. They haven’t been in the world that long and everything is new and fresh for them, as a result they tend to live in the moment and tend not to dwell on the past or worry about the future.
Parents of young children often complain that their children have problems remembering things, but children tend to focus on what’s relevant to them in this particular moment. Young children generally lack the capacity to think about the possible consequences of their actions – they tend to adopt and “try it and see” approach rather than being able to think it through in their heads and thus avoid making a mess!
It can be difficult to children to say how they are feeling largely because they lack both the skill of inner reflection and the vocabulary to effectively communicate what’s happening with them. Parents report that it can be very frustrating as they have to be very vigilant and intuit what their child may be feeling.
Children themselves may not be aware that they have any kind of memory problem as such. They can learn to be concerned about possible problems from their parents and other family members, but left to themselves, very young children tend not to worry about such issues as to whether they will ever learn to read or not – they tend to think simply in terms of what they like or don’t like to do (i.e. it’s easy or difficult for me to do).
The mismatch between the focus of attention for children and parents can be the cause of a great deal of upset within families.
Pituitary conditions in children can cause problems with cognitive development and learning in children. Children may not worry about their condition in the same way that an adult would, but their condition can cause them to have difficulties concentrating, which (as we discussed in part 1 of this series of articles) then has a knock-on effect in terms of what they are able to remember later.
Obviously, there is the matter of having to attend various clinic appointments in school time which can lead to children falling behind in their school work. Having said that, most young pituitary patients get back on track after treatment, once their hormone therapy has been sorted out for them. There are a few who may be left with permanent learning difficulties, particularly if they’ve needed more extensive surgical treatment and/or radiotherapy.
As well as the brain development that takes place for us as teenagers, some researchers think that the brain undergoes further development during young adulthood (i.e. between the ages of 20 and 40 years).
They cite evidence that suggests that the ability to control mood and emotion emerges in people around about the age of 25- to 30-years when the frontal lobes develop to the point where they can regulate (control) the limbic system (the emotion centre of the brain).
Additionally, many brain scientists believe that the ability to integrate different brain systems in this way doesn’t become fully developed until early adulthood.
Short term memory tends to remain stable during early adulthood, decline somewhat during middle adulthood (40- to 60-years) and decline more noticeably in late adulthood. Middle-aged adults have a better ability to concentrate and make decisions than younger adults.
Interestingly, researchers have noticed that older we get the more forgetful we think we are. However, if you think about the demands that we tend to make of ourselves (running a house, taking care of other people etc) then the experience of being forgetful can simply be the symptom of our own expectation that we should be able to remember more than our short term memory system can actually cope with.
There is some interesting research which suggests you are more likely to lose objects as you age – it seems older adults find it more difficult to remember objects and where they saw them than younger people do.
As we noted earlier, the precise cause of any memory problems is hard to pin down. Effects are influenced by age at diagnosis and treatment (whether in childhood, young adulthood, middle or old age).
As we grow and age, the impact of a pituitary condition in terms of short term memory is going to vary greatly, and will obviously be affected by the type of pituitary condition, too. We hope that some of the practical hints and tips about how to cope with any problems you experience will be helpful.
If you are in the middle of treatment at present, be optimistic; usually pituitary patients notice a gradual improvement in symptoms with time, as you are treated and your hormonal status is re-balanced and optimised.